Provider Demographics
NPI:1902001639
Name:BUTLER, KEVIN DONNEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DONNEL
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 ALAMO DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-4146
Mailing Address - Country:US
Mailing Address - Phone:940-224-1599
Mailing Address - Fax:
Practice Address - Street 1:1302 WEST PAYNE STREET
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:TX
Practice Address - Zip Code:76374
Practice Address - Country:US
Practice Address - Phone:940-564-4689
Practice Address - Fax:940-564-4689
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2049450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist